Provider Demographics
NPI:1154096493
Name:MONTOYA, TATUM MARIE
Entity Type:Individual
Prefix:
First Name:TATUM
Middle Name:MARIE
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TATUM
Other - Middle Name:M
Other - Last Name:ROBERGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:260 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-4115
Mailing Address - Country:US
Mailing Address - Phone:747-644-6702
Mailing Address - Fax:
Practice Address - Street 1:66 TROY ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3023
Practice Address - Country:US
Practice Address - Phone:508-676-5708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health